The physiology and pathology of the cerebellum

THE

physioloctY and pathology

CEEEBELLTJM

BY

WILLIAM A. HAMMOND, M. D., \

PROFESSOR OF DISEASES OF THE MIND AND NERVOUS SYSTEM, AND OF CLINICAL MEDICINE,
IN THE BELLEYXJE HOSPITAL MEDICAL COLLEGE ; VICE-PRESIDENT OF THE ACADEMY
OF THE MEDICAL SCIENCES ; OF THE NATIONAL INSTITUTE OF LETTERS,

ARTS, AND SCIENCES, ETC., ETC., ETC. j

i i

[FSOM THE qUARTEELY JOURNAL OF PSYCHOLOGICAL MEDICINE AND
MEDICAL JURISPRUDENCE FOR APRIL, 1869.]

NEW YOEK:
T). APPLETON & COMPANY,

90, 92 & 94 GRAND STREET.
1869.

L W. SCHMIDT, 24 Barclay Street, New York.

THE

PHYSIOLOGY AND PATHOLOGY

OF THE

CEREBELLUM.

PKOFESSOB OF DISEASES OP THE MIND AND NEKVOTJS SYSTEM, AND OF CLINICAL MEDICINE,
IN THE BBLLEVUB HOSPITAL MEDICAL COLLEGE ; VICE-PRESIDENT OF THE ACADEMY
OF THE MEDICAL SCIENCES ; OF THE NATIONAL INSTITUTE OF LETTERS,
AETS, AND SCIENCES, ETC., ETC., ETC.

{FROM THE QUARTEBLY JOURNAL OF PSYCHOLOGICAL MEDICINE ANB
MEDICAL JURISPRUDENCE FOB APRIL, 1869.] '

BY

WILLIAM A. HAMMOND, M. D.,

NEW foEK:
D. APPLE TON & COMPANY,

90, 92 & 94 GEAND STEEET.
1869.

THE

PHYSIOLOaY AND PATHOLOGY

OP THE

CEEEBELLUM.

(Eead before the JSTew York County Medical Society, January 4, 1869.)

The anatomical relations of tlie cerebellum are so
distinct as regards size, position, and structure, that
physiologists, ever since tlie development of their
science, have sought with great assiduity to discover
its fanctions. First one view and then another has
been brought forward and urged by argument and by
appeals to pathology and experiment, but each has in
its turn lost ground with time, until now it is certain
that no one theory obtains undivided acceptance, if it
even commands a majority in its favor. It is, at first
sight, difficult to account for this skepticism. The or-
gan in question is one which can readily be submitted
m living animals to observation and experimental re-
search ; it is in great part devoid of sensibility, it may
be pricked and torn and electrized and cauterized
with impunity, and in some animals may even be al-

4

THE PIIYSIOLO&Y AISTD PATHOLOGY

together removed, and life still remain for a long
time. It might, therefore, he fairly supposed that
these circumstances Avould have led to some definite
results. So far, however, from this being the case, they
have tended to increase the obscurity of the subject,
for it is very certain that the functions of an organ,
which can be mutilated or entirely ablated without the
production of notable and uniform consequences, can-
not be very pronounced in their character, even though
indispensable to the permanent well-being of the ani-
mal.

Before the time of Willis the functions of the cere-
bellum were confounded with those of the cerebrum.
This author is declared b}^ Vulpian to be the founder
of cerebellar physiology, but his works contain little
more than fanciful hypotheses unsustained by facts.
He regarded the cerebellum as presiding over the in-
voluntary motions, as being the organ of music, and as
a generator, by its cortical substance, of the animal
spirits.

Foville,' basing his ideas on the anatomical arrange
ment and the relations of the cerebellum to the spi-
nal cord, regards it as the centre of common sensation.
This view is likewise entertained by Pinel, Grand-
champ, and Duges. Experimental physiology and
pathology do not, however, support the hypothesis,
for it is found that injury, disease, or even complete
removal of the organ in question, produces no nota-
ble diminution of sensibility in any part of the
body.

Passing over several other theories which have been

^ Traite Complet de I'Anatomie, de la Plijsiologie, et de la Patliologie
du Sjstfeme Nerveux. Paris, 1844.

OF THE CEEEBELLUM.

5

advanced, relative to tlie functions of the cerebellum,
tliere are two wliicli I proj^ose to consider somewhat
' at length. These are, first, that it is the originator and
controller of the sexual appetite, and, second, that it
coordinates the various muscular actions of the body.

The first theory originated with Gall, and, though
it met with great opposition when it was promulgated,
and though it is still vigorously cc^nbated, there is a
good deal of evidence in its favor. Doubtless much
of the odium in which it is held is due to the fact that
numerous ignorant pretenders to science have embraced
it. This, however, should not prevent us investigating
its pretensions with fairness.

Numerous cases of injury and disease of the cere-
bellum attended with derangement of the generative
function are referred to by Combe ' and other wTiters.
Larrey," in an elaborate paper, sustains Gall's theory,
and adduces several cases in its support. He alleges
that acute inflammation of the cerebellum is always ac-
companied with an exalted state of the animal and or-
ganic sensibility, without there being any disturbance
of the intellectual functions. If the injury or disease
be located in only one of the lobes, the increase of
sensibility will be found on the same side of the body,
and will be attended in various gradations by acute
pain ill the occipital region, horripilations, gradual or
convulsive contractions of the muscles of the face and
of the upper and lower extremities of the affected side,
together with painful formication in the fingers and
toes. Should paralysis supervene, it is always, he as-

' A System of Phrenology. Boston, 1834, p. 110.
* Observations on Wounds, etc. Translated from the Fi-ench by E. F.
Kivinus, M. D. Philadelphia, 1832, p. 1:9.

6

THE PHYSIOLOGY AND PATHOLOGY

serts, confined to the muscles on that side of the body
corresponding to tlie diseased or injured side of tlie
cerebellum.

In case the patient recover, lie will, according to
Larrey, be subjected to some remarkable infirmities,
sucli as a feelino; of excessive tenderness in th.e neck
and occipital region, and a decided astkenia of tke gen-
ital organs, combined with atro23hy of the testicle of
the side whick corresponds to tke diseased lobe of tke
cerebellum, or of botk, if tke Avkole of tkis part of tke
encepkalon be affected.

In support of kis remarks, Larrey cites tke case of
a young soldier, wko, in Egypt, was struck on tke back
of tke kead by a large splinter of wood. Inflammation,
supposed to be located in tke cerebellum, supervened.
He eventually so far recovered as to be sent to France.
Several years elapsed before ke again came under Lar-
rey's notice. It was tken found tkat kis genital or-
gans were reduced to tke size of tkose of an infant a
few montks old ; tke power of erection was lost, and
sexual desire kad disappeared.

In anotker case, a soldier was struck by tke ball of
a blunderbuss, wkick, grazing tke occipital protuber-
ance, tore away tke extensor muscles of tke kead in
its passage from one side to tke otker. " Tke patient
immediately felt a violent pain in tke occiput and a
sense of Aveigkt in tke wkole kead, togetker witk numb-
ness of tke lower extremities. His vision and kear-
ing were so muck impaired tkat ke could kardly dis-
cern any large objects or understand tke most piercing
sounds. His testicles became reduced and wasted
away, and kis penis diminisked in tke same propor-
tion, and lost tke power of erection."

OF THE CEREBELLUM.

7

Tlie third case was that of a man who had received
a sabre-cut through the occipital bone and dura mater,
so that the right lobe of the cerebellum could be read-
ily seen and touched. When the finger was pressed
upon it, ever so gently, vertigo, syncope, and convul-
sions were induced, but no pain was experienced. Af-
ter the first few days the patient lost the faculties of
vision and hearing on the right or affected side. At
the same time there was violent pain along the course
of the spine, and a kind of formication in the testicles,
the size of which rapidly diminished, so that in less
than a fortnight they were reduced to the size of small
beans. The sexual passion became utterly extin-
guished.

In the fourth case, the patient was struck on the
back of the head ; among other consequences, the right
testicle became atrophied, and the power of erection
lost.

In the fifth case, in consequence of a blow on the
head with a piece of wood, an abscess of the right lobe
of the cerebellum was produced, of which, in about
three months, the patient died. The post-mortem exam-
ination showed entire disorganization of the right lobe,
and marked atrophy of the testicle of the afii'ected side.

In the sixth case, disease of the cerebellum was the
consequence of erysipelas. The patient lived two
months subsequently. The post-mortem examination
revealed the existence of an abscess which had entirely
taken the place of the left lobe of the cerebellum. The
scrotum and penis were so much reduced from their
original size as to be in the second stage of atrophy.

Two other cases are cited, in which disease of the
testicles led to supposed atrophy of the cerebellum.

S THE PHYSIOLOGY AKD PATHOLOGY

It is wortli noticing tliat in no one of these cases was
any difficulty in coordinating tlie muscles perceived.

Without citing other cases similar to those of Lar-
rey, and which are familiar to the profession, I desire
to refer to three remarkable instances, the details of
which are given by Dr. Jolm D. Fisher,' of Boston, but
which appear to have escaped the notice of recent
writers :

The first was that of a man aged forty-five, who
was seen soon after his death, which took place from
pneumonia. The penis was small ; the glans had evi-
dently seldom, if ever, been uncovered. When ex-
posed, it was small, pale, and pointed ; all the parts of
the organ resembled those of a boy not yet arrived at
the age of puberty. The scrotum was soft and fiabby,
and was empty. No testicles were anywhere to be
found.

The head was large, measuring 22 inches in cir-
cumference. The brain was healthy and very large,
weighing 51i ounces. The relative proportion of the
cerebellum to the cerebrum was much reduced, for,
while the latter weighed 47 ounces, the former weighed
but 4J ounces. According to Meckel and others, the
average weight of the cerebrum and cerebellum, united,
is 48 ounces — and the weight of the cerebellum to that
of the cerebrum is as 1 to 7, or 1 to 8. In this case,
the cerebellum measured, in its transverse diameter, 4
inches ; in its antero-posterior diameter, 2^ inches ;
and in thickness, 1|- inch; ordinarily, it measures,
transversely, 4 inches ; antero-posteriorly, 2^ inches,
and perpendicularly, 2^ inches. It was, therefore, one-

1 Ooutributioas illustrative of the Functions of the Ceiebellum. Amei'-
icaa Journal of the Medica] Sciences, February, 1839.

OF THE CEEEBELLUM.

9

tliird less in size and weiglit than is ordinarily tlie case
in an adult male, and was tlie exact weiglit of that of
a female cliild six years old, whose body was examined
at tlie same time.

The history of the patient is very interesting. The
deficiency of testicles was discovered by Dr. Warren.
His voice was like that of a woman ; he had no beard,
he never exhibited any amorous propensities, or desire
for female society — as his mother expressed it, he was
a virgin in feeling and conduct to the day of his death.

The second case was that of a man aged forty-one,
who, while a passenger in a railway train, was injured
by a collision, so that the bach 23art of his neck was
struck violently against the w^indow-frame of the car.
The blow was so severe, that he remained for some
time in a state of insensibility ; at first, it was thought
that his skull was fractured, or his neck dislocated.
He, however, regained his intelligence, and was con-
veyed to his residence. On visiting him an hour after
the accident, Dr. Fisher found him suffering great pain
in the occipital portion of the head and upper part
of the neck. He was lying on his back, and was
unable to rotate his head or move from a horizontal
position. Every attempt to do so was attended with
excruciating pain. The muscles of the neck and integ
uments were swollen, but there were no indications
of fracture of the cranium, or of fracture or dislocation
of the vertebrae.

On the second day after the accident, he complained
of numbness of the right arm, and of a difficulty in
passing his urine. Another interesting symptom
occurred after two weeks when he had left his bed.
He lost the power of estimating distances; near objects
appeared to be far off, and to be far below him. The

10 THE PHYSIOLOGY AND PATHOLOGY

street seemed to be of interminable length, and lie felt
as if lie were very mucli taller than the persons with
whom he conversed. Between the fourth and fifth
week after his accident, he made the discovery that he
had lost the desire and physical jDOwer for sexual inter-
course; the ordinary excitations failed altogether in
causing any amorous feeling, and this condition, he
was of opinion, had existed since the reception of the
injury. In the course of four months, the bladder
recovered its contractile power, but the arm remained
numb for several months longer. The generative
function continued dormant for two years, and six
months later was only partially active.

The third case is related by Dr. Whittemore. An
old man, aged seventy-three, had been married forty
years, and had had eleven children. Soon after mar-
riage, he began to complain of dizziness and noises in
the head, to which he was more or less subject till his
death. Four years before this event, he experienced,
on rising from bed, for three or four mornings in suc-
cession, excruciating pain in the head, which was fol-
lowed by a sensation as if something had given way in
the left side of the head with an audible crack, which
led him to inquire if the bystanders had not heard the
sound, and he was astonished to find they had not.
After this he became partially deaf in the left ear, and
the dizziness increased. During these dizzy turns, he
was obliged to catch hold of the nearest object to keep
from falling, and at such times every thing seemed to
be whirling about like wheels, with a motion always
from right to left. Two years subsequently, he had an
attack of hemiplegia, and subsequently experienced
two other attacks, all slight. After the occurrence of
these, he had a morbid salacity, which continued with

OF THE CEEEBELLTJM.

11

little iiitermissioii till about three montlis before liis
death, when it began to subside, so that the desire
became imperious but once or twice during the night.
There was, however, no ability to gratify it, owing to
imperfect erection ; and for a year there had been no
seminal emission. During this last period, he had been
gradually getting worse, and his mind had lost most
of its power. A few weeks before his death, he had
two epileptic attacks.

On the day after his death his head was examined.
The dura mater was adherent to the skull, the arach-
noid was thickened, there was a large quantity of
serous fluid in the pia mater, and the arteries were
undergoing ossification ; otherwise, the brain was
healthy, except as regarded the cerebellum. The right
lobe of this organ was healthy ; the left lobe was one-
fifth smaller, and was found to have lost the greater
part of its substance owing to the formation of a cavity
in its tissue. The sides of the cavity were in contact,
but it had probably contained serum, which had es-
caped when it was laid open. A coagulum, the size
of a duck-shot, was found in the left crus, a small por-
tion of which was destroyed by disease. As remarked
by the author, we have in this case a somewhat remark-
able proof of a relation existing between the cerebellum
and the instinct of reproduction. The revival of the
instinct and powers of propagation, which had been
extinguished for years, taking place on the accession
. of a disease of the cerebellum, and continuing active
till the organ began to lose its firmness of texture, and
to undergo disorganization, is strong confirmation of
the evidence furnished by the two preceding cases, that
this part of the brain is the source and centre of the
instinct.

12

THE PHYSIOLOGY AND PATHOLOGY

Tlie noticeable features of these cases, besides the
derangement of tlie sexual appetite, are tlie entire
absence, in all, of any symptoms indicating a loss of
tbe power of coordination, and the presence of vertigo
in the third case. (This, it will be recollected, was the
only one in which either of the crura cerebelli were
alfected.) It will be noted, also, that the hemiplegia
occurred upon the side of the body opposite to that
of the disease in the cerebellum.

' Georget,^ whose works upon the brain and nervous
system are so important, and who has so carefully stud-
ied the manifestations of the mind in health and dis-
ease, writes as follows relative to the point under con-
sideration :

" Physicians have observed certain phenomena of
the generative organs in cerebral affections. Thus,
erection has been noticed by Bichat as a symptom of
such disorders. It is not rare in ataxia [Georget does
not here refer to locomotor ataxia, as now recognized,
but to an affection described by Pinel, characterized
by loss of strength and general enfeeblement of the
power of sensation and motion]. M. Serres has seen
it in two cases of disease of the cerebellum, of which
one consisted of an extravasation of blood, and the other
of an inflammation. It is well known that individuals
who are hung frequently exhibit this phenomenon, and
that others have been so depraved as to cause them-
selves to be suspended by the neck in order to j)rocure
the power of satisfying their venereal desires

" M. Gall j)laced the seat of j)hysical love in the
cerebellum. Of all his other phrenological doctrines,
this is the one in reo-ard to which he has brous-ht for-

' De la Physiologie du Systeme ISTerveux et specialeraent du Oerveau,
etc. Paris, 1821, vol. ii., p. 163.

OF THE CEEEBELLTIM.

13

ward the greatest amount of proof. The cases of M.
Serres are liere of some weiglit. M. Larrey cites
the case of a young soldier who had received a sabre-
cut on the back of the neck, and who never thereafter
experienced any venereal excitement. Hippocrates
assures us that the Scythians rendered themselves
impotent by dividing the veins behind the ears. This
tradition, although not founded on fact, indicates,
nevertheless, that they had recognized a connection
between the nape of the neck and the genital organs.
Ferrand, in his treatise De la maladie amour ^ ou
melancolie erotique, assures us that physicians have
obtained benefit by the aj)plication of leeches to the
nape of the neck of patients affected with this disease.
I have myself seen, at the Salpetriere, a woman of ardent
temperament, whose only mental derangement consisted
in imperious venereal desires. Before her entrance
into the hospital she had frequently had sexual inter-
course ten or fifteen times a day. During her stay,
she was very often seized with a violent pain in the
nape of the neck, and at the same time experienced the
most irresistible sexual desires, which she satisfied by
masturbation ten or fifteen times a day. These acts
did not appear to injure her, and soon caused the pain
in the occiput to disappear."

Many other cases, similar to those I have referred
to, might be readily adduced, were it necessary to do
so. The fact may be regarded as unquestionable, that
lesions of the cerebellum do occasionally give rise to
abnormal sexual manifestations, either of increase or
diminution. What the physiological and jDathological
importance of this point may be, I propose next to
inquire.

Researches into the comparative anatomy of the

14

THE PHYSIOLOGY AND PATHOLOGY

subject go to disprove Gall's theory. Tlie Amjpliioxus
lanceolatus is a vertebrate, tlie lowest of tlie fishes, and
is devoid of a cerebellum. The organ, therefore, is
not necessary for the performance of the reproductive
functions. ISTo observations have been made, so far as
I am aware, relative to the strength of the sexual pas-
sion in this singular animal.

Passing u|)ward a little, we come to the lamprey,
in which, as likewise in the sturgeon, polypterus, and
lepidosiren, the cerebellum consists of a simple commis-
sural bridge or fold. In these fish the generative
organs are extraordinarily large, and in the lamprey
the sexual instinct is unusually developed, for, during
the act of copulation, they are stated by Owen ' — and
as I have myself often observed — to entwine or wreathe
themselves about each other, and thus mutually aid
in the expulsion of their respective generative prod-
ucts. So absorbed do they become in their passion,
that they permit themselves to be taken out of the
water and replaced without interrupting the act. The
cerebellum is smaller in the lamprey than in any other
fish.

In the shark, on the contrary, it is largest, but it is
well known that the sexual passion is very feeble in
this animal.

Among reptiles, the frog has the smallest cere-
bellum, and yet this creature is remarkable for its
strong sexual manifestations, which are so powerful
that it will continue to embrace the female even after
its fore-feet have been amputated. In fact, as I have
ascertained by experiment, the removal of the cerebel-
lum in this animal does not destroy the sexual pro-
clivity.

* Anatomy of the Vertebi-ates. Vol. i. Fishes and Reptiles, London,
1866, p. 287.

OF THE CEEEBELLTJM. 15

In birds, the cerebellum is large and very much
more developed tlian in the fishes or reptiles. It is
marked by circumvolutions or transverse lamellae, which
vary in number, in different birds, according to the
greater or less size of the cerebellum. According to
Leuret,' the number of these lamellse is never less than
ten nor more than twenty.

Now, as regards the generative function, it will
not, I think, be found that there is any direct ac-
cordance between its power and the number of the
cerebellar lamellae. In the chicken they number four-
teen, and in the goose, sixteen. Yet the former is
undoubtedly more salacious than the latter. In the
pigeon and others of the dove family, they number six-
teen, and in the magpie, twenty ; but the former are
remarkable for their excessive amorous passion, while
in the latter it is by no means a noticeable character-
istic.

Among mammals the cerebellum reaches its highest
state of development, and in man its utmost degree of
size and comj)lexity of structure. But we find no cor-
respondence between this organ and the sexual appe-
tite such as Grail has attempted to establish. In the
cat, for instance, the cerebellum is for a mammal slight-
ly developed, the lateral lobes being very small, but no
one will contend for the existence of slight sexual pas-
sion in this animal. In regard to this point, Dr. Car-
penter says :

" A friend who kept some kangaroos in his garden
informed the author that they were the most salacious
animals he ever saw — yet their cerebelkmi is one of
the smallest to be found in the class (mammalia).

' Anatomie Coinparee du Sjsteme Ferveux. Paris, 1839-1857, t. i.,
p. 281.

16

THE PHYSIOLOGY AND PATHOLOGY

Every one knows, again, tlie salacity of monkeys ,
there are many wMck are excited to violent demon-
strations 1by tlie sigkt even of a human female, and
there are few which do not practise masturbation
when kept in solitary confinement ; yet in them the
cerebellum is much smaller than in man, in whom the
sexual impulse is much less violent."

Budge ' made the discovery that in females irrita-
tion of the cerebellum caused movements in the cor-
nua of the uterus and tubes. He also found that a
like exciting cause produced, in the male, movements
of the testicles and vasa deferentia. Thus he says :

" By a lucky coincidence I made the gratifying ob-
servation that in an old cat whose testicles lay in the
abdominal cavity, these organs immediately after death
moved whenever the cerebellum was irritated with the
scalpel or with caustic potash. The effect was such
that, whenever the right lobe of the cerebellum and
the right half of the vermiform process were irritated,
movement of the left testis ensued, and the reverse.
Mere superficial irritation sufiiced to produce this re-
sult. The movement of the testicles soon became so
palpable in this animal that there could be no doubt
as to its reality. I hastened to oj)eii the entire skull
and the abdominal cavity, and found the testicles lying
perfectly still, without any trace of movement. On
irritating one side of the cerebellum, the testicle of the
opposite side swelled, quitted its position, and rose up
so as to form a right angle with the spermatic cord, one
side of the angle being directed forward. If I desisted
from the irritation, the testicle returned to its position,
and the movement was renewed on renewing the irri-

TJntereuchungen ilber das Nervensystem. No. ii., p. 82.

OF THE CEEEBELLUM.

17

tation. The experiment was repeated during lialf an
liour, witli unvarying results. After the first irritation,
not three seconds elapsed before the movement fol-
lowed ; subsequently, the interval between the irrita-
tion and the effect was prolonged. The movement
only lasted a short time, and was diminislied more and
more. Alternately with the cerebellum, I irritated the
cerebrum, the corpora quadrigemina, the thalami op-
tici, the corpora striata, but I have never seen the slight-
est movement result from the irritation of these parts."

Valentine confirms Budge's observations, but Volk-
mann has never been able to do so, and Miiller dis-
credits them altogether.

I have endeavored to satisfy myself in regard to
these points, by repeating Budge's experiments. In
one instance, in whicli a cat was used, decided move-
ments of the testicles were induced by irritating the
cerebellum with a scalpel, or with the continuous gal-
vanic current, applied througb two needles. The irri-
tation of the left lobe produced movements in the right
testicle, and vice versa. When the current was passed
through both lobes, both testicles were moved, and the
penis was also brought into a state of erection. I was
at first disposed to attacli considerable importance to
these facts, as indicating a very close relation between
the cerebellum and the generative organs ; but, by fur-
ther observation, I found that irritation of the medul-
la oblongata and of the cerebrum produced like move-
ments in both testicles and the penis. I also found that
irritation of the cerebellum, in either way I have speci-
fied, caused movements of the intestines, of the abdom-
inal muscles and of the muscles of the thigh and back.
My experiments were performed upon three cats just
killed. I am hence disposed to attach less importance to

3

18 THE PHYSIOLOGY AND PATHOLOGY

Budge's observations than does Eomberg/ who quotes
tliem witli evident approbation. They are, neverthe-
less, interesting, as showing that, though the connection
between the cerebellum and the sexual organs is not
exclusive, there is a relation, in which, however, other
parts of the body participate, and which, likewise, ex-
ists with other parts of the brain.

Coming now to man, we find numerous facts which
are altogether irreconcilable with Gall's hypothesis.
We have seen that there are many cases of injury and
disease of the cerebellum on record, which tend to
show that there is some connection between this organ
and the sexual passion. Observation, however, shows
us that, as in the lower animals, other parts of the
cerebro-spinal axis participate in this connection, and
that the integrity of the cerebellum is not at all essen-
tial to the existence of strong venereal propensities.

In the first place, blows upon the back of the neck
are more apt to injure the spinal cord or medulla ob-
longata than the cerebellum. The same is true of
hanging — so that the cases of these kinds, brought for-
ward in support of Gall's theory, prove at least as much
for these organs as they do for the cerebellum.

Burdach' collected one hundred and seventy-eight
cases of injury and disease of the cerebellum, of which
but ten exhibited any aberration of the sexual func-
tion.

In his classical treatise, Ollivier' (d' Angers) refers
to fifteen cases (thirteen occurring in his , own expe-

* A Manual of the Nervous Diseases of Man. Sydenham Society Trans-
lation, vol. ii., p. 33.

^ Yom Baue unci Leben des Gehirns. Leipsic, 1819-1826 ; vol. iii.,
]), 423.

^ Trait6 des Maladies de la Moelle fipinifere. 3d edition, Paris, 1837 ;
t., i. pp. 316-367.

OF THE CEEEBELLIJM.

19

rience) of lesions attended witli compression of the
spinal cord in tlie cervical region, in eight of wMch
there was erection of the penis. In thirteen cases of
similar lesions in the dorso-lumbar region, erection
occurred in three.

AndraP declares that, in thirty-six cases of disease
of the cerebellum, permanent erection of the penis was
present in one only ; and, in this, the tubercular mass
constituting the disease pressed upon the superior part
of the spinal cord.

A preparation in the Anatomical Museum, at Bonn,
is. as Miiller^ states, unfavorable to Gall's opinion. It
is the cerebellum of a man, in whom half the organ
was found atrophied. Death had been caused by an
inflammatory disease. But the sexual passion had
been rather strong than weak. The man was married,
and the father of several children.

But the most remarkable case is one reported by
M. Combette," whose paper is entitled " Case of a young
girl who died in her eleventh year, in whom there was
com23lete absence of the cerebellum of the posterior
peduncles, and of the annular protuberance." I shall
refer to this case more at length when I come to dis-
cuss another theory of cerebellar function. At pres-
ent I will only state that the girl's name was Alexan-
drine Labrosse, and that Magendie satisfied himself by
careful examination that the defect was congenital. She
entered the Hopital Saint Antoine, where she died.
M. Combette asserts that he had obtained the certain
knowledge that this girl practised masturbation.

' Clinique Medical, t. v., 2d edition, p. 735.

^ Elements of Physiology, translated by Baly, vol. i., p. 832 ; quoted
from Wagner in Nova Act., Nat. Cur., xiv., p. 111.

^Journal de Physiologie Esp6rimentale et Pathologique. Par. F.
Magendie, t. xi., Paris, 1831, p. 27, et seq.

20

THE PHYSIOLOGY AND PATHOLOGY

I have witnessed tliree cases of injury of tlie spinal
cord, in wliicli tliere were painful and frequent erec-
tions, and two in wliicli the faculty seemed to be alto-
gether lost. The usual influence of disease of the cord,
such as congestion, meningitis, and myelitis, is in the
early stages to produce frequent erections ; later in the
course of these affections, the symptom disappears.
In white softening of the cord, the j)ower of erection
is lost very soon.

In two cases of general paralysis under my care, in
which there was no reason to suspect any cerebellar
lesion, erections, accompanied with strong sexual de-
sires, occurred among the first symptoms. As the
disease advanced toward a fatal termination, these
symptoms became absent.

Gall asserts that the loss of the testicles causes
atrophy of the cerebellum. This opinion has not been
sustained. Leuret ' made many investigations relative
to the point, and found that in geldings the average
weight of the cerebellum was 7 0 grammes ; in stallions,
61, and in mares, 61. The proportionate weight of the
cerebellum to the cerebrum was in geldings as 1 to
5.97 ; in mares, as 1 to 6.59, and in stallions as 1 to
7.07. So far from the cerebellum decreasing from cas-
tration, it was found that the cerebrum lost weight from
this cause.

Now, if the cerebellum were the sole or even the
chief originator of the sexual impulse, it ought, judging
by analogy, to have decreased in size after castration.
Instances of the dependence of structural integrity
upon the excitation due to functional activity are so
frequent, that it is scarcely necessary to cite them.

The other hypothesis relative to the function of the

^ Anatomie Oompar^e du Systeme Nerveux, t. i., p. 425, et seq.

OF THE CEREBELLCIM.

21

cerebellum is tliat whicli ascribes to it the power of
coordinating the various muscles of the body so as to
make them act in harmony, and to obey exactly the
mandates of the will.

Although Rolando/ in 1809, asserted, from numer-
ous experiments, that the cerebellum is the source and
origin of all muscular movements, the theory which
regards it as especially the coordinator originated with
Flourens in 1822 and 1823, and was published by him
in papers read in those years before the French Acad-
emy. My account of it is obtained from the second
edition of his work on the nervous system,' published
in 1842.

Flourens performed his experiments on birds and
mammals : among the former class, upon the pigeon,
turkey, swallow, sparrow, owl, and duck; among the
latter, on the dormouse, cat, mole, and dog. His
method was to cut away the organ in successive slices.
In all his experiments, disorder of movement was pro-
duced, and this disorder was the more marked, accord-
ing to the extent of the mutilation — till, at last, the
animal fell, unable to move at all. Flourens states, in
regard to all of them, that their motions were like those
produced by drunkenness. He shows, likewise, that
the cerebellum is insensible ; that its injury or removal
does not interfere with the senses of sight or hearing,
and that volition and memory are not abolished. A
blow aimed at an animal thus injured is seen, and the
effort is made to avoid it, but the power to do so is
lost. Injury of one side of the cerebellum affects the
muscles of the opposite side of the body.

^ Saggio sopra la vera struttura del cervello, etc. Sassari, 1809.
^ Eecberches Exp6rimentales sur les Propri6t6s et les Fonctions du
Systeme Nerveux. Second edition, Paris, 1842.

22

THE PHYSIOLOGY AND PATHOLOGY

Harting ' repeated Flourens's experiments, and witli
analogous results. He found that the cerebellum was
devoid of sensibility ; tliat convulsions were not induced
by its irritation ; tliat the senses remained in a state of
integrity, and that no other function appeared to be
affected except that which relates to order in the move-
ments. He also noticed that, in those cases where the
mutilation had been partial only, the power of regu-
lating the motions was soon regained.

Bouillaud, Longet, and many others have obtained
results similar to those of Flourens, and have drawn
]ike conclusions from them.

But, very soon after the publication of Flourens's
Memoirs, Magendie went over the ground and de-
clined to accept his hypothesis. He states ' that hedge-
hogs and Guinea-pigs, from which he had removed not
only the cerebellum', but the cerebrum also, rubbed
their noses with their fore-legs when a flask of vine-
gar was applied.

Now, one such instance, well authenticated, is suffi-
cient to overturn Flourens's hypothesis ; for, if one ani-
mal can coordinate its movements when deprived of
its cerebellum, then that organ is not absolutely es-
sential to such coordination. Nevertheless, Flourens's
views upon the subject have been largely accepted, and
probably no other theory of cerebellar function can
count as many adherents.

The arguments which may be brought against it
are, however, so forcible, and experiments performed
upon animals of different classes are so strikingly
against it, that I am forced to regard his doctrine as un-

^ Experimenta quseclam de affectibus Isesionum in partibns enceplialo,
1826.

PrScis £l6mentaire de Physiologie. Quatridrae Edition. Paris, 1836,
t. i., p. 408.

OF THE CEREBELLUM.

23

tenable. In addition, tlie records of patliology furnisli
evidence whicli is absolutely fatal to its pretensions :

First. TJie consequences of removal of the cerehel-
lum^ if tlie animal survives the immediate effects of the
o^eration^ are not enduring.

Flonrens himself found tbat tliere was greater weak-
ness and hesitation of motion immediately after tlie
operation than at a subsequent ]3eriod. Harting found
that the full power eventually returned.

Wagner/ in 1858, says of animals, fi'om which the
cerebellum has been removed :

" The most prominent feature of these phenomena
is, that they disappear comj)letely, or at least in great
part, at the end of half an hour, or an hour, if the animal
is allowed to rest in a comfortable position. When the
animals survive the operation, and after the wound is
healed, they continue to walk, though in a somewhat
uncertain manner, with the feet wide apart, notwith-
standing that a considerable portion of the cerebellum
may liave been removed. In the generality of cases
all the symptoms disappear in a few days, and the ani-
mals recover the faculty of walking, flying, etc., It is,
therefore, very probable that the phenomena, which
are manifested immediately after the operation, are
due to slight injuries or shocks to the deeper parts, such
as the peduncles of the cerebellum or the medulla ob-
longata, and that momentary troubles are consequently
produced in the muscles corresponding to these parts."

Dalton's ' experiments are to the same effect. He
says :

^ Fachricliteii von der TJniversitat und der Konigl. Gesellschaft der Wis-
senscliaften zu Gottingen. Also Journal de la Physiologie de rHonime et
des Animaux, Avril, 1861.

^American Journal of the Medical Sciences, January, 1861, p. 88.
Also Treatise on Human Physiology, 4th edition, 1867, p. 416.

24

THE PHYSIOLOGY AND PATHOLOGY

" In tlie montli of January, 1859, I removed from
a young but well-grown male pigeon, wliile under tlie
influence of ether, the upper and middle portions of
the cerebellum, constituting about two-thirds of its
entire mass. Immediately afterward the pigeon showed
all the usual effects of this operation in a very marked
degree. He was incapable of walking, of flying, or even
of standing still, but struggled and sprawled about
exactly as other pigeons had done when subjected to a
similar mutilation. He was used very successfully to
illustrate the effects of this operation before the medi-
cal class.

"This pigeon, however, contrary to my expectation,
survived, and in the course of a few days it was evi-
dent he was recovering the control of his limbs. This
recovery continued to go on at the same time, with the
general reestablishment of the animal's health, and at
the end of five or six days he was again very nearly
capable of executing all his natural motions — ^his ap-
petite was also restored, and he ate and drank freely,
as before the operation."

This pigeon lived for sixteen days, at the end of
which time he was purposely killed. During his life,
after the operation, he got along very well, eating, fly-
ing, walking, and even fighting the other pigeons
which attempted to take his food.

Examination showed that about two-thirds of the
cerebellum had been removed. No attempt at repro-
duction had been made.

I have performed several similar experiments to
the same effect. On one occasion I removed somewhat
more than two-thirds of the cerebellum from a crow.
The animal was at first affected in the characteristic
manner, but gradually it regained its normal condition,

OF THE CEEEBELLUM.

25

and was able to fly, walk, hop, and to alight with
great exactness. It lived for tliree months after the
operation, and was then accidentally killed.

In another experiment, npon a cliicken-cock, I re-
moved more tlian lialf of tlie cerebellum. For a few
hours the animal was unable to stand, and kept con-
tinually moving its head in a gyratory manner, as if
aftected with vertigo. Gradually these phenomena
disappeared, and in a few days the animal was not to
be distinguished in his movements from other roosters.
Several months afterward, he was killed, and, upon
examination, it was found that the remaining portion of
the cerebellum down to the peduncles had disappeared.
It was a noticeable fact that the amorous propensi-
ties of this bird were not abolished by the operation,
but that he still continued to perform his marital duties.

2. Tlie entire removal of the cerehellum from some
animals does not apparently interfere in the slightest
degree^ even for a moment^ loith the i^egularity and order
of their movements.

I have extirpated the cerebellum from the gold-fish
{Garpo^^ the sun-fish {Pomotis)^ the gar {Lepidosteus)^
the trout {Salmo^^ the perch {Percd)^ and other genera
of fish, without observing the least irregularity of
movement. The animals swam and balanced them-
selves in the water, as well without as with a cerebel-
lum.

From frogs I have removed it very many times,
without in the slightest degree, so far as I could per-
ceive, impairing their powers of motion or of coordina-
tion. I have also frequently extirpated it from snakes,
lizards, and turtles, with like results.

I know it may be alleged that the movements of
fish and reptiles are very simple, and that therefore

26 THE PHYSIOLOGY AND PATHOLOGY

thej have no use for a cerebellum. But this arguruent
will not stand. They do have a cerebellum, and, in
order to perform their various movements, they must
coordinate. Neither are their movements always so
very simple. The fisli, in balancing itself in the water,
in avoiding obstacles, and in seizing its food, often ex-
ercises a great deal of coordinating power. The lizard
is remarkable for its agility, and for the accuracy of its
movements, in catching its prey.

In relation to serpents, their motions are too often
regarded as consisting of simple lateral vibrations of
their bodies. But in reality their movements are very
complex, Owen ' calls attention to this general error,
and says :

" Serpents climb trees by the same mechanism and
actions as in the first kind of locomotion ; the edges of
the erected scutes laying hold of the bark in succession
as the body glides spirally up the bough. The tail has
a prehensile faculty, especially exercised by the great
constrictors while waiting for their prey

" Serpents are too commonly looked down upon as
animals degraded from a higher type, but their whole
organization, and especially their bony structure, de-
monstrates that their j)arts are as exquisitely adapted
to the form of their whole and to their habits and
sphere of life as any animal which we call superior to
them. It is true that the serpent has rio limbs, yet it
can outclimb the monkey, outswim the fish, outleap
the jerboa, and, suddenly loosing the close coils of its
crouching spiral, it can spring into the air and seize the
bird upon the wing ; all these creatures have been
observed to fall its prey. The serpent has neither

1 Oa the Anatomy of the Vertebrates, vol. i., 'Fishes and Reptile?,'
London, 1866, p. 261.

OF THE CEKEBELLUM.

27

hands nor talons, yet it can out wrestle tlie athlete,
and crush the tiger in the embrace of its ponderous
overlapping folds. Instead of licking up its food as it
glides along, the serpent uplifts its crushed prey and
presents it grasped in the death-coil as in a hand to its
slimy, gaping mouth."

It is true that frogs in jumping and swimming
simply flex and extend their legs, but they must, never-
theless, flex and extend them synchronously or dis-
synchronously according as they desire to move direct-
ly forward or obliquely, and therefore must coordinate.
Besides, many of their motions are more complex, such
as turning themselves on their bellies after being
placed on their backs, applying their feet to the exact
seat of an irritation in order to remove it, etc. In the
tree-frog {Ilylci) — ^from which I have also removed the
cerebellum without deranging the motional powders of
the animal — the movements are such as to require still
more coordinating j^ower. In turtles, the number and
variety of the movements are extensive, and the ability
to coordinate correspondingly great. Yet in these
animals removal of the cerebellum does not appear to
interfere in the least with the integrity and harmony
of the muscular actions.

3. Tlie disorder of movements luliicli results in hirds
and mammals immediately after injury of the cere-
helium is not due to any loss of coordinating power ^ hut
is tlie result of ^vertigo,

Tlie careful examination of the phenomena exhibit-
ed by a pigeon after ablation of the cerebellum shows
that it is suffering from a vertigious sensation. Even
when placed on its breast and allowed to remain at rest,
there is a trembling and swaying of the body such as
is produced by alcoholic intoxication. Now, under

28

THE PHYSIOLOGY A^TD PATHOLOGY

sucli circumstances, there are no muscular actions to
coordinate, and yet tlie animal makes efforts witli its
wings to preserve its equilibrium. When it attempts
to walk, it staggers and instantly endeavors to maintain
its balance. Flourens always speaks of this phenomenon
as laeing like that exhibited by a drunken animal —
but fails to distinguish it from that which would be
exhibited if the coordinating power were lost. I have
several times rendered cats, rabbits, and Guinea-pigs
drunk with whiskey. Their movements are exactly
like those which result in other animals after injury of
the cerebellum. My friend Professor A. Flint, Jr., in-
forms me that he has recently made pigeons drunk, and
that they act like those which have suffered injury of
the cerebellum. I have recently performed similar ex-
periments upon several pigeons. In every case the ap-
pearance and actions of the animal were not to be
distinguished from those which occur after removal of
the cerebellum. There were the same sprawling of the
wings, the same hesitating and staggering gait, the same
uncertainty of flight, the same ineffectual efforts to
avoid a blow, and the same gyratory motion of the
head and trembling of the body. I do not believe the
most experienced experimental physiologist could dis-
tinguish between two pigeons, one of which was drunk
and the other suffering from an injury of the cerebel-
lum. I propose to show the difference between the
]3henomena of vertigo and incoordination under another
division of the subject.

4. The phenomena of cerebellar disease or injury^
as exhibited in man^ are not such as show any derange-
ment of the coordinating power.

Reference has already been made to the case of Al-
exandrine Labrosse, reported by Combette. It is stated

OF THE CEEEBELLXJM.

29

that when she entered the hospital she had but little
intelligence, appeared indifferent to wliat was going on
around her, though she eyinced gratitude to those who
nursed her. When she was spoken to, she answered
with hesitation and difficulty. Her limbs, although
weak, were yet strong enough to allow of her walking,
though she often fell. She possessed all her senses
She ate moderately, and all her functions of nutrition
were well performed.

A year afterward, she had been constantly in bed
for three months, her face was pale, and her counte-
nance exhibited an appearance of stupor and of a dete-
riorated constitution. She remained constantly on her
back, with her head inclined to the left. She could
hardly move her limbs, but the sensibility was not di-
minished. She used her hands readily — and when ad-
dressed only answered yes or no, but always correctly.
She died on the 21st of March, 1831, fifteen months
after her admission to the hospital, and at the age of
eleven years.

JJ^pon post-mortem examination the cerebellum was
found to be entirely absent. In its place there was a
cellular gelatiniform membrane, semicircular in shape,
and about eighteen or twenty lines in length. There
was no pons variolii.

As M. Combette remarks, Alexandrine Labrosse
had been able to walk for several years, although al-
ways in an uncertain manner. Gradually her legs lost
their strength, and she became paraplegic. Besides, she
preserved the use of her upper extremities up to the
last. It is very evident, therefore, that the weakness
of her legs was due to paralysis — for, had it been the
result of incoordination, the arms must necessarily have
participated. In conclusion, M. Combette says, after

30 THE PHYSIOLOGr AISTD PATHOLOGY

giving it as Ms opinion that tlie case is antagonistic to
Flourens's theory :

" However tliat may be, it remains certain tliat tliis
girl lived v\^itliout a cerebellum, posterior peduncles, or
cerebral protuberance — and tliat slie probably v^^ould
liave continued to live if an abdominal affection liad
not put an end to her days ; that she nevertheless en-
joyed the faculties of sight, touch, and hearing; that, if
her intelligence was only slightly developed, there was
not a complete absence of ideas ; and that, though there
was paraplegia, this had always been incomplete, for the
sensibility had never been diminished."

Magendie, in his comments on the case, after minute-
ly examining the brain, gives ifc as his decided opinion
that the absence of the cerebellum was congenital.

M. Combette refers to two other cases, in one of
which there was a large tumor in the left lobe of the
cerebellum, and in the other an abscess in the same
position, in neither of which was there any difficulty
of locomotion.

M. Lallemand ' cites the case of the vicar of Geze-
ville, aged forty-six years, who for a year had experi
enced attacks of vertigo and vomiting, without fever.
He staggered in walking, and often fell forward. On
examining his brain after death, the membranes of the
cerebellum were found to be depressed and shrivelled,
and to contain only a little brown and fetid lymphatic
purulent liquid,

AndraP states that, of ninety-three cases of cere-
bellar disease which he has studied, only one appeared
to support the theory which locates the coordinating
power in this organ.

^ Eecherclies Anatomico-patliologiques sur I'Encephale, etc. Paris,
1824.

" Olinique Medicalo, seeonde edition, t. v., p. 735.

OF THE CEEEBELLUM.

31

On tlie 27tli of February, 1836, M. Bouvier ' com-
municated to tlie Academic de Medecine tlie particulars
of the case of a man wlio, for a length of time, had been
subject to a discharge from the ear, with deafness and
frequent headache. He was suddenly seized with an
attack of yerj severe headache,. vomiting, and disorder
of mind. Three weeks afterward he entered the Hotel
Dieu. He was then suffering from fixed pain in the
head, obtuseness of sensibility, somnolency, vomiting,
etc. The movements of all the limbs were preserved.
A week subsequently he died. Post-mortem examina-
tion revealed, as had been foretold, the existence of
caries of the temporal bone. But there was also found
an abscess involving the two outer thirds of the left
hemisphere of the cerebellum ; the walls of this cavity,
which contained several tablespoonfuls of pus, were
softened.

As M. Bouvier remarks, a circumstance of great in-
terest connected with this case is the entire absence
during life of any symptoms indicating an augmented
sensibility, loss of equilibrium, or excitation of the
genital organs. Passing over a number of other cases
which could be cited, I desire to relate l^riefly the par-
ticulars of two which came under my own notice.

In 1851, a Mexican shepherd was attacked near
Cebolleta, in New Mexico, by Navajo Indians. He
managed to escape, but in fleeing from his enemies
received an arrow-wound in the posterior part of the
head. He was on horseback, and, though stunned by
the blow, maintained his seat in the saddle. So firmly
was the arrow implanted that the shaft became de-
tached by his efforts to remove it, leaving the head of
the weapon in the skull. I saw him about two hours

^ American Medical Intelligencer, April 1839.

82 TPIE PHYSIOLOGY AND PATHOLOGY

subsequently. He was tlien in full possession of liis
senses and was suffering no pain. Tliere were, however,
constant vertigo and nausea, together with a sensation, as
he described it, as if his head, w^ere balanced on a very
delicate point, and the least inclination to one side or
the other would cause it to fall off. On examining the
wound, I found the arrow-head still sticking in the bone,
and I had to use considerable force before I could re-
move it. It had entered to the extent of an inch and
a half — a little below and to the left of the occipital
]3rotuberance — wounding the left lobe of the cerebellum.
The vertigo continued all that night, but the nausea
and vomiting stopped in the course of a few hours.

The next day he attempted to walk, but was
obliged to desist on account of the vertigo. " He felt,"
he said, " as if he were drunk," and he staggered just
like a drunken man. This feeling of vertigo continued
for several weeks, lasting all through the period of sup-
puration. Gradually it disappeared, though, even after
the lapse of a year, he felt giddy on making any un-
usual physical exertion. At no time was there any
difficulty in coordinating the muscles of the upper or
lower extremities. The latter were simply affected
through the vertigious sensation. The sensibility was
unaffected throughout the whole progress of the case.

The other case was that of a man who, for several
months, had suffered with vertigo, occasional convul-
sions, attacks of nausea, and vomiting, and a constant
and violent pain affecting the back of the head. These
symptoms had come on subsequently to a severe blow
which he had received on the back of the head, in con-
sequence of raising himself too soon while the horse he
was riding was passing under a low archway.

When this man attempted to walk he reeled and

OF THE CEEEBELLUM.

33

staggered as if lie were drunk, but Ms movements
were very different from those wiiicli we now recog-
nize as cliaracterizing locomotor ataxia. The upper
extremities and the organs of speech were not affected ;
he had the entire control of his legs when lying down,
and there w^as no diminution of sensibility anywhere.
At last he became paraplegic, and shortly afterward
died in a convulsion. The post-mortem examination
showed the existence of an abscess, which had oblit-
erated nearly the whole of the left lobe of the cere-
bellum.

Four cases are now under my charge in which I
have reason to suspect the existence of cerebellar
disease. In one of these — that of a gentleman of this
city — there is intense pain in the occiput, almost con-
stant vertigo, and slight hemiplegia. When he attempts
to walk, his gait is staggering, but he lifts his feet in
perfect coordination, and can stand alone, with his
eyes shut and his heels close together. He can place
either foot, without any difficulty, on any particular
spot on a chair, and can carry a glass full of water to
his lips ^vithout spilling a drop or looking at it. He
has no derangement of the coordinating faculty in any
part of his body, but complains of constant vertigo,
which is manifestly increased whenever he attempts
to walk. The sensibility is intact.

In another case, that of a gentleman from the West,
similar symptoms exist. There is intense occipital
pain, slight hemiplegia, confined to the right leg, ver-
tigo, and attacks of nausea and vomiting. The giddi-
ness is so constant that he has it even in his sleep,
and is often waked by the disagreeable feeling it
causes. He coordinates perfectly, but cannot walk
without the support of a cane, owing to the vertigo.

3

34

THE PHYSIOLOGY AND PATHOLOGY

There is no disturbance of sensibility. This gentle-
man puts on bis stockings and boots witbout assistance ;
can place tbe big toe of either foot on any point of a
cbair ; can carry a glass full of water to bis moutb ;
can write, and even thread a needle, — and yet in tbe
street be is often taken for a drunken man. I need
not say tbat tbe performance of tbe above-mentioned
acts would be utterly impossible to a person alfected
witb locomotor ataxia.

Tbe otber two cases bave very recently come under
my notice. One of tbem is tbat of a gentleman occu-
pying a prominent position, wbo bas almost constant
pain in tbe back of bis bead, and vertigo, from wbicb
be bas suffered about two years. In tbe beginning be
bad, in all probability, an extravasation of blood into
tbe left lobe of tbe cerebellum, for be bas a slight
hemiplegia of tbe right side, and the pain is located
on the left side. He informs me that the vertigo is
often so great tbat be cannot walk without falling;
he staggers now witb every step, but yet coordinates
perfectly. In this case there have been no erections
for a year and a half

The other case is that of a married woman, 45
years of age, sent to me a day or two ago by my
friend Dr. Woolsey Johnson, and who is afflicted
with the most extreme and constant desire for sexual
intercourse. So great is this impulse, that she has
been in the habit of practising masturbation as many
as twenty times a day. She has a severe pain in the
occiput, and almost continued vertigo ; there is slight
paralysis of the left arm. When she walks, her gait
is staggering, and she says that every thing in the
room looks as though it. were in motion. There are
no indications of any irritation about tbe vagina. She

OF THE CEREBELLUM.

35

informs me that tlie intensity of tlie pain and tlie
desire for sexual intercourse are in direct relation to
each other. She coordinates all lier muscles perfectly
well.

In the Neiu Yorh Medical Journal for June, 1867,
I detailed, under the head of Convulsive Tremor, the
j)articulars of several cases which. I thought consisted
in fanctionxHl cerebellar disease. In each of these
there was pain in the occiput, vertigo, and an uncon-
trollaMe tremor, which came on in paroxysms.

Derangement of locomotion does, therefore, result
from injury or disease of the cerebellum. Experi-
mental physiology, as well as pathology, proves this.
Beyond a doubt, the disorder is, however, clearly due
to vertigo. There are, moreover, headache, vomitings,
and eventually, in some cases, hemiplegia, generally
of the opposite side to that of the cerebellar lesion, a
fact at variance with Larrey's assertion. The gait of
a person thus affected is exactly similar to that of
a drunken man. As Carre ' says, the movements are
not abrupt, jerking, and exaggerated, as they are in
locomotor ataxia. They are more uncertain, and do
not depend upon any defect of coordination, but uj)on
weakness of the voluntary power.

When either of the peduncles of the cerebellum is
affected there is an irresistible impulse to go sideways,
and sometimes gyratory movements are produced.

The researches of M. Bouillaud," of MM. Leven
and Olivier," and of M. Duchenne, are absolutely con-
clusive on this j)oint.

^ Nonvelles RecTaerches sur I'Ataxie Locomotrice Progressive, etc.
Paris, I860, p. 270.

^ Union M^dicale, t. ii., 1859.
^ Archives Gengrales, 18G2 1863.

86

THE PHYSIOLOGY AND PATHOLOGY

5. In iJiose diseases, of wJiicli tlie cliief ])lienom-
ena relate to derangement of the coordinating power,
tTie lesion is not in the cerehelhim, and the symptoms
are altogether different from those due to cerebellar
disease or injury.

Tlie affection known as locomotor ataxia is chiefly
manifested by incoordination. If the cerebellum wevQ
tbe seat of the coordinating power, we should expect to
find the lesion in this organ. Such, however, is not the
case. A few cases of so-called locomotor ataxia have
been reported, in which it was said the cerebellum
was found diseased; but careful examination shows
that these were cases of cerebellar disease attended
with vertigo. In true locomotor ataxia the lesion is
always found in the posterior columns of the sj)inal
cord, or in the posterior roots of the spinal nerves.

Moreover, in the ataxic form of aphasia, in which
the patient can write, can move the tongue and lips
in all possible directions, and yet is unable to so coor-
dinate the muscles of speech as to enunciate words,
the lesion is not found in the cerebellum, but in the
posterior part of the third convolution of the anterior
lobe of the left cerebral hemisphere.

Eelative to the symptoms which seem to distin-
guish cerebellar disease from locomotor ataxia, the
line is well defined. The chief difiiculty has been,
that authors have failed to distins-uish between the
effects of vertigo and the consequences of a loss of the
coordinating power. Flourens himself, as we have
seen, made this mistake, and Dr. Todd and others
have repeated it. Thus Dr. Todd ' says : " Animals
deprived of the cerebellum are in a condition very
similar to that of a drunken man, so far as relates to

* Oyclopasdia of Anatomy and Pliysiology, vol. iii.

OF THE CEEEBELLUM.

37

tlieir power of locomotion. They are nnaUe to pro-
duce that combination of action in different sets of
muscles which is necessary to enable them to assume
or maintain any attitudes." ' Now, the first sentence
is true of cerebellar disease, but not of locomotor
ataxia, of which disease vertigo is not a symptom,
neither is the gait of an ataxic patient at all like that
of a drunken, man. The second sentence is true of
persons suffering from locomotor ataxia, but is not
true of those who have a lesion of the cerebellum, and
who are able to coordinate perfectly well.

In lesions of the cerebellum the cutaneous sensi-
bility remains unimpaired ; in locomotor ataxia, on
the contrary, it is always affected.

Duchenne, Avho at one time held the opinion that
locomotor ataxia was a disease, the seat of which was
in the cerebellum, has lately recanted, and now con-
tends that there is no relation between them. He
brings forward several cases which are conclusive as
to this point.

I have thus endeavored to clear up several impor-
tant points relative to the physiology and pathology of
the cerebellum. In the course of my inquiry I have
performed a great many experiments uj)on different
animals, and have thus arrived at what I think is a
correct view of the physiology of the organ in ques-
tion. We have seen that it has no special and exclu-
sive control over the sexual appetite, and no particular
function to perform in connection with coordination.
My opinion is, that it has no special or exclusive func-
tion of any kind, but that it is simply an additional
generator of nervous power, a ganglion to be added

^ Diagnostic Differential des Affections C6i-ebelleuses et de I'Ataxie
Locomotrice Progressive. — Gazette Hebdomadaire^ 186G.

38 THE PHYSIOLOGY AT^D PATHOLOGY, ETC.

to the cerel^riim, and performing analogous offices in
the economy. I advance this theory not without hesi-
tation ; but, so far as my observation extends, both
experimental physiology and pathology appear to
unite in establishino; its correctness. If I do not now
adduce the j)roofs in detail, it is because I am fearful
of having already wearied you with a subject which,
though interesting and important, both in its purely
scientific and practical relations, I am conscious of
having very imperfectly brought to your attention.